Nicotine Withdrawal.

Hello,

Thank you for choosing DoctorSpring.

I have discussed your case with our team Cardiologist.
Your current symptoms are :

Fatigue
Anxiety
Lightheadedness
Acid Reflux

While these symptoms can occur with Nicotine withdrawal these are not specific for withdrawal. Moreover the timings also do not suggest withdrawal. Withdrawal symptoms starts within few hours last for around a week to 10 days. Then it starts decreasing in severity.

Since you have been well evaluated and a cardiac cause has been ruled out I suspect a GAD - Generalised Anxiety Disorder with a Panic attack component.

1.I would like to know whether you are constantly worried about something ?
2.Do normal activities of daily living makes you anxious ?
3. Are you stressed about something in work or personal life ?
4. Do get any irrational fears ?
5. Would you say "your mind is always full with something"
6. Generally are you more pessimistic these days ?

You can reply as a followup.
Thank you

Hello Dr. Deepu,

I do however feel my symptoms dissipating as the day and weeks goes by, my fatigue levels are now almost gone. However, the acid reflux and heart burn is still there. I am now exactly 4 weeks since my last cigarette.

I have read somewhere that nicotine withdrawals last anywhere between 2 weeks to a few months, not too sure about that?

I forgot to tell you that doctors also did a chest x-ray, liver, kidney and thyroid function test, all ok.

Following your question:

1) Yes I am worried about having another heart-palpitation episode because it feels terrible to have one. The last time I had one was 4 weeks ago, and I was not anxious at all, it just came out of no where.

2) Yes I have been cooped up at home because the thought of going out make me feel light-headed. Not too sure if that is the fatigue.

3) I am stressed about my impending flight back to Australia on Monday, as I am studying there and have already missed 3 weeks of school.

4) I do worry at times, but not too sure if that is "irrational fear".

5) Yes my mind is always occupied with something, but it can be both positive thoughts and negative.

6) Not really, I am really optimistic about my recovery. I know that I can recover fast, as I have from mycoplasma with my full blood count returning to normal.

I am not too sure if I am suffering from GAD because I do not have a history of GADs, and as said, the heart palpitation came out of no where whilst I was relax and having dinner. However, that day I was also having an extreme hang-over, so not too sure if it was caused by alcohol as well.

Not too sure if the fatigue (though improving) is caused by post-viral fatigue syndrome or nicotine withdrawals as well.

Thank you doctor :)

-Zen-

Hello Zen,

From your replies you do not seems to have a GAD . Still I would not bat for Nicotine withdrawal. Nicotine withdrawal for a young person with 1 year history of smoking will be mild - moderate. The most prominent symptom will be an intense craving for a smoke. Other symptoms like fatigue, depression, anxiety etc could be mild and as I said it peaks in fews days and then goes down. (Yes is some cases it can last even upto few months. ) Post Mycoplasma infection fatigue could be a cause.

Anyway since you are symptom free now there is nothing to worry. Do continue Rabeprazole. Make sure you are taking it early morning or just before bed (without any food).
If a Thyroid Function test was not done, you should consider getting it done. Putting a diagnosis could be difficult as the symptoms are bit non specific. But that's not really necessary since you are making good progress.
Do keep me updated. I will keep this consult open, so that you can get back to me anytime.

Hope this helps
Thank you

Hello Doctor Deepu,

Thank you for your re-assuring words :)

A thyroid function test was done, and everything is normal. So as a liver and kidney function test :)

The only very minor and mild symptom I have these few days are still acid-reflux and heart burn (especially when Im lying down to sleep). Abit of light-headedness that comes and goes, usually in the afternoon. And I guess I still feel bait tad anxious.

I do have the occasional cravings for a nicotine hit as it relaxes me, I usually smoke to cope with stress (especially in school).

How long does post-infection fatigue last? Though I seem to be fairly good today, I just came back from a 30mins walk around my estate to get some sunlight and fresh-air :)

Thanks!

-Zen-

Hello Zen,

Post infectious fatigue can last several weeks to months. But I think you have mostly recovered. The acid reflux is nothing to be worried about. Remember stress is a major precipitant of acid reflux. So keep yourself engaged with work, study, friends and family. Take Rabeprazole as recommended.

The nicotine craving you have is more psychological than physical. So you can easily resists it. Make sure you do not have cigarette packets with you to avoid impulsive smoking. And as I said earlier, keep yourself occupied. Quitting smoking is much easier than portrayed. Even if you fail couple of times try again.

Hope this helps
Thank you

Hello Doctor Deepu,

From my specialist's letter (uploaded for you), I need help in understanding this, so does that mean I do not have mycoplasma?

"Physical examination on 25/02/14 was unremarkable. Mycoplasma antibody titer of 1:80. As discussed, he has no serological evidence of recent Mycoplasma infection and no further antibiotics are required.”

I also feel the occasional cooling sensation in my chest, especially after I lie down. Is this acid indigestion? Why is it still happening even though I have been on 5 days of 40mg Rabeprazole?

Thanks!

-Zen-

Hello,

As per your Doctor's letter the repeat Serology of Mycoplasma showed same results. If it was a recent Mycoplasma infection the serology values (1/80) should double or triple. If it stays same it is not diagnostic of Mycoplama. So it is possible that infection was not Mycoplasma. It could be an unrelated viral infection. The coldess in chest could be from the acid reflux. You need to continue taking the medication. Avoid coffee, spicy foods.

Hope this helps
Thank you